Sophie Plagerson

Poverty and mental disorders: breaking the cycle in low-income and middle-income countries

Growing international evidence shows that mental ill health and poverty interact in a negative cycle in low-income and middle-income countries. However, little is known about the interventions that are needed to break this cycle. We undertook two systematic reviews to assess the effect of financial poverty alleviation interventions on mental, neurological, and substance misuse disorders and the effect of mental health interventions on individual and family or carer economic status in countries with low and middle incomes. We found that the mental health effect of poverty alleviation interventions was inconclusive, although some conditional cash transfer and asset promotion programmes had mental health benefits. By contrast, mental health interventions were associated with improved economic outcomes in all studies, although the difference was not statistically significant in every study. We recommend several areas for future research, including undertaking of high-quality intervention studies in low-income and middle-income countries, assessment of the macroeconomic consequences of scaling up of mental health care, and assessment of the effect of redistribution and market failures in mental health. This study supports the call to scale up mental health care, not only as a public health and human rights priority, but also as a development priority.

Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa

Abstract Globally, the poor are consistently at greater risk of suffering from depression and anxiety. Yet in resource-poor countries, mental health remains a neglected topic. This interdisciplinary study explored the potential for a poverty alleviation programme to contribute to breaking the vicious cycle between poverty and common mental disorders (CMD). Quantitatively, beneficiaries of a cash-transfer programme were found to have a lower risk of CMD. Qualitative interviews indicated that Child Support Grants acted as a psychological safety net, but that negative stereotypes of grant recipients could detract from the positive mental health outcomes of the grants. It was concluded that poverty alleviation programmes such as cash transfers could have both positive and negative impacts on mental health. In order to achieve mental health benefits for programme beneficiaries, aspects of programme design and implementation that promote mental health should be enhanced and aspects detrimental to mental health modified.

Global trade and mental health.

The consequences of the unprecedented growth of global trade on development and population health are significantly influenced by global trade policies that have delivered millions from poverty, but have constrained the ability of governments to regulate their economies and protect health. While the effects of global trade policy on health have been documented, mental health considerations have been very limited. This analysis explores the impact of global trade policy on a number of socio-structural determinants of mental health including poverty, social inequality, food security, mental health systems, alcohol consumption, access to pharmaceuticals and occupational health. The evidence reviewed makes a strong argument that global trade is likely to have a significant impact on mental health. However, the mental health outcomes of global trade will be influenced by a host of contextual factors and will therefore be heterogeneous. Preliminary recommendations for discussion are considered.

Poor housing, good health: a comparison of formal and informal housing in Johannesburg, South Africa

ObjectivesThis study aimed to investigate the relationship between housing, demographic, socio-economic, social factors and health, in poor urban communities in Johannesburg, South Africa.MethodsData were drawn from a survey of 1,427 households in Johannesburg. The outcome health variable was a composite measure of chronic ill-health. Housing variables included type of housing, tenure and access to services. Multivariate regression analysis assessed the relationship between housing and health, after adjustment for demographic, socio-economic and social factors.ResultsThe prevalence of chronic health problems was 25.1% (95% CI 22.8–27.6%). Factors independently associated with the risk of chronic ill-health among household heads included older age (OR, 3.06 [2.37–3.95]), female gender (OR, 2.83 [2.01–3.97]), long-term residence (OR, 2.01 [1.10–3.67]), unemployment (OR, 0.49 [0.36–0.67]), and living in formal housing (OR, 0.66 [0.45–0.98]).ConclusionsThe health of the household heads residing in informal housing was significantly better than in formal housing. Explanations for this counter-intuitive finding include the fact that the informal housing dwellers were younger and recent migrants (the ‘healthy migrant’ phenomenon). Policy implications of the results are identified.

Poverty and mental illness: Fact or fiction? A commentary on Das, Do, Friedman, McKenzie & Scott (65:3, 2007, 467–480)

a School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa b Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa c London School of Hygiene & Tropical Medicine, London, UK d Department of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK e Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Can social protection address both poverty and inequality in principle and practice

The recent expansion of social protection in the Global South has focused on practice (the how) and not on principles (the why). The Sustainable Development Goals (SDGs) endorse social protection as a means of addressing both poverty and inequality. In this article, which contributes to the Special Issue on ‘The principles and practice of social protection’, we focus on the principles that (often implicitly) underlie four types of social protection responses to poverty and inequality. The analysis of moral, economic, political and social arguments shows a convergence on the need to alleviate poverty, but the principled agreement to tackle inequality is weaker as it requires a broader mandate and more extensive state intervention. Regardless of strong moral/social arguments, dominant economic/political arguments are less inclined to accept the type of social protection required to address inequalities.

Changing an Urban Community Through Health Research A South African Case Study

This article reflects on a positive example of health research translation. Research conducted in a disadvantaged urban community in Johannesburg by the World Health Organization Collaborating Centre for Urban Health as part of the Health Environment and Development study led to a number of community-led health promotion initiatives. Using the Research and Policy in International Development framework for analyzing the links between research and practice, the process and outcomes that have transformed local approaches to health are reviewed. Lessons learned may prove useful to others seeking to use health research to influence local approaches to health.

Social Protection and Social Development

This chapter first defines social protection and locates it within the social development approach. Then, it provides a geographical and historical overview of social protection and outlines some of the key trends that are the focus of current debates. In the conclusion, future implications of the recent rise of social protection on the development policy agenda are discussed. It is argued that although social protection measures are becoming popular in many countries, they will continue to be negotiated in contexts of demographic and labour shifts, rising inequality, political and ideological contestation and climate change. .

The principles and practice of social protection

Social protection programmes used to be seen as the prerogative of rich countries. Over the past 20 years, the Global South has embraced, adapted and popularised social protection as a genuine channel for achieving poverty reduction and development goals. The speed of this expansion, and the urgency of its ever-expanding aims, has perhaps left little time for reflection regarding the philosophical antecedents that underlie social protection. Implicitly or explicitly, these act as a rudder for directing social protection in practice. The diverse portfolio of social protection programmes that have emerged globally provides evidence that the rich and dynamic ideological, political and social settings into which new programmes and institutions are introduced are vital to setting a course for social protection trajectories. Different ethical frameworks can lead to very different social protection outcomes. Principles, founded in thoughts of fairness and moral obligations, need to be clearly articulated. As such, principles can direct social protection policies towards achieving a more just society. However, as social protection initiatives have expanded rapidly, practical issues related to legislation, targeting, financing, implementation, management and technology often take centre-stage, leaving ethical underpinnings understated, or silent. We maintain that a thoughtful analysis of the innovative, bold and enterprising developments in social protection in the Global South, and of the real interactions between principles and practice, can help support a new global chapter for social protection. In this Special Issue, we take as our starting point the post-2015 Sustainable Development Goals (SDGs), the successors of the Millennium Development Goals, in which social protection is endorsed as an effective instrument for achieving both poverty eradication and inequality reduction. Such a strategic platform undoubtedly augurs well for the future global expansion of social protection. The SDGs will represent a negotiated and pragmatic international consensus around a mandate for action. Yet, such an agreement by its nature does not make explicit an ethical framework (from which principles flow) or a blueprint for action (practice). A robust ethical mandate can help to